IVR Technology as a scalable tool to support medication compliance and persistence

The empowerment of people to take greater control and responsibility of their health and careIVR and its potential in automated patient support

02/03/11102/03/11Message Dynamics LtdCOPD Monitor

PROMs Post elective surgeryPost discharge from tertiary care

Medicines Management

Home deliveries & visit appointments

Smoking cessation outcomes

Minor Ailments follow up

Message Dynamics LtdMessage Dynamics LtdCase Study: COPD MonitorChest Clinic, King Edward VII Hospital, WindsorIVR is part of the care package offered to all patients with COPD

Having been critical of the frequent flyer paradigm I now have to confess that we started that way.

We received NHS funding late 2010/early 2011 to build an application that Must offer the prospect of reduced admissions, be responsive to the quality & productivity agenda, have scale and the potential for wide impact, be a sound return on the investment, improve patient and staff experience, give rapid results and be clinically acceptable.

In June last year we started piloting it with this hospital and as of September 1st they have offered it to all COPD patients referred to them as part of their care package.

These patients are frequent flyers; they have been referred to the Chest Clinic by their GPs, are all at the severe/very severe end of the COPD spectrum and all have experienced multiple emergency admissions.

So what do we do?

We use Interactive Voice Technology or IVR. A computer calls each patient twice a week. It asks them how 5 of their symptoms compare to the last time they were called.

Here is an extract of what it sounds like. SPEAKER

Depending upon how they answer an alert is triggered and fired off to the Clinic.

Patients like it very much. They perceive it as an intrinsic component of the totality of care they receive. But they also perceive that it is saving the NHS money because they are not wasting anybodys time and it is part of the goal of keeping them out of hospital.

And the Units nurses like it too. Patients say it keeps them focused on what is important and the nurses seem to concur. They also feel it is helping them allocate their time and effort most productively.

4Message Dynamics LtdNurses perceive that two thirds of these visits avoided an admissionPeriod: 1st September 2011 to 18th April 2012

Patients alert at a rate of 13 per 100 callsPrincipal causes of an alert are increased sputum production & the development of a new coughCost of the service = 25p per call70% of alerts are dealt with by a call from the COPD TeamNow for some hard numbers.

In the 6 months 1st September to 29th February the IVR system held 1,494 conversations with patients, each lasting an average 105 seconds.

200 alerts were generated, a rate of 13%. One quarter of these high risk patients generated no alert at all. But I hope by now that this statistic does not surprise you: even the most frequent of frequent flyers spend most of their time on the ground.

The most common causes of alert were the development of a new cough, the production of more sputum and a combination of both. I defer to clinicians who tell me these are the indicators of potential acute exacerbation.

The Chest Clinics nurses follow up on each alert with a phone call. These phone calls dealt with 70% of the cause of the alert by, for example, advising the patient to take their antibiotics, to use their nebuliser or simply by giving reassurance.

The remaining 30% required a home visit so that the nurse could, for example, listen to their patients chest. They then took the appropriate action.

Not all patients would have ended up in hospital if the nurse had not visited but the nurses perceptions are that by intervening quickly they saved about two thirds being admitted. That is 40 admissions.

It cost 410.50 to make the IVR calls.

So, what might things look like if this sort of thing was done for people with COPD at a national scale?

5Benefits for Patients and the NHSMessage Dynamics Ltd